Dave Sagar, Shah Aakash, Galvagno Samuel, George Kristen, Menne Ashley R, Haase Daniel J, McCormick Brian, Rector Raymond, Dahi Siamak, Madathil Ronson J, Deatrick Kristopher B, Ghoreishi Mehrdad, Gammie James S, Kaczorowski David J, Scalea Thomas M, Menaker Jay, Herr Daniel, Krause Eric, Tabatabai Ali
Department of Surgery, Program in Trauma, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
Department of Surgery, Division of Cardiac Surgery, School of Medicine, University of Maryland, Baltimore, MD 21201, USA.
Membranes (Basel). 2021 Apr 2;11(4):258. doi: 10.3390/membranes11040258.
The most critically ill patients with coronavirus disease 2019 (COVID-19) may require advanced support modalities, such as veno-venous extracorporeal membrane oxygenation (VV-ECMO). A systematic, methodical approach to a respiratory pandemic on a state and institutional level is critical.
We conducted retrospective review of our institutional response to the COVID-19 pandemic, focusing on the creation of a dedicated airlock biocontainment unit (BCU) to treat patients with refractory COVID-19 acute respiratory distress syndrome (CARDS). Data were collected through conversations with staff on varying levels in the BCU, those leading the effort to make the BCU and hospital incident command system, email communications regarding logistic changes being implemented, and a review of COVID-19 patient census at our institution from March through June 2020.
Over 2100 patients were successfully admitted to system hospitals; 29% of these patients required critical care. The response to this respiratory pandemic augmented intensive care physician staffing, created a 70-member nursing team, and increased the extracorporeal membrane oxygenation (ECMO) capability by nearly 200%. During this time period, 40 COVID-19 patients on VV-ECMO were managed in the BCU. Challenges in an airlock unit included communication, scarcity of resources, double-bunking, and maintaining routine care.
Preparing for a surge of critically ill patients during a pandemic can be a daunting task. The implementation of a coordinated, system-level approach can help with the allocation of resources as needed. Focusing on established strengths of hospitals within the system can guide triage based on individual patient needs. The management of ECMO patients is still a specialty care, and a systematic and hospital based approach requiring an ECMO team composed of multiple experienced individuals is paramount during a respiratory viral pandemic.
2019冠状病毒病（COVID-19）最危重的患者可能需要高级支持手段，如静脉-静脉体外膜肺氧合（VV-ECMO）。在州和机构层面上，对呼吸道大流行采取系统、有条不紊的应对方法至关重要。
我们对本机构对COVID-19大流行的应对措施进行了回顾性研究，重点是创建一个专门的气锁生物安全隔离单元（BCU）来治疗难治性COVID-19急性呼吸窘迫综合征（CARDS）患者。通过与BCU不同层级的工作人员、负责建立BCU和医院事件指挥系统的人员进行交谈，收集有关正在实施的后勤变更的电子邮件通信，以及回顾2020年3月至6月我们机构的COVID-19患者普查数据。
超过2100名患者成功入住系统医院；其中29%的患者需要重症监护。对此次呼吸道大流行的应对增加了重症监护医师的配备，组建了一个70人的护理团队，并将体外膜肺氧合（ECMO）能力提高了近200%。在此期间，40名接受VV-ECMO治疗的COVID-19患者在BCU接受管理。气锁单元面临的挑战包括沟通、资源短缺、双人病房安排以及维持常规护理。
在大流行期间为大量重症患者做准备可能是一项艰巨的任务。实施协调一致的系统层面方法有助于根据需要分配资源。关注系统内医院已有的优势可以指导根据个体患者需求进行分诊。ECMO患者的管理仍然是专科护理，在呼吸道病毒大流行期间，基于医院的系统方法，由多名经验丰富的人员组成ECMO团队至关重要。
